Healthcare Provider Details

I. General information

NPI: 1407768930
Provider Name (Legal Business Name): MARIAH LEE PERA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CAMPUS DR
HANCOCK MI
49930-1452
US

IV. Provider business mailing address

926 9TH ST
LAKE LINDEN MI
49945-1145
US

V. Phone/Fax

Practice location:
  • Phone: 906-483-1000
  • Fax:
Mailing address:
  • Phone: 906-370-9272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501304476
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: